Global Patterns of Skilled Birth Attendance, Socioeconomic Factors, and Maternal Mortality

Ayman Assaaoudi

doi:10.18192/osurj.v5i1.8074

Global Patterns of Skilled Birth Attendance, Socioeconomic Factors, and Maternal Mortality

Authors

Ayman Assaaoudi University of Ottawa, Ottawa, ON, Canada

DOI:

https://doi.org/10.18192/osurj.v5i1.8074

Abstract

Skilled birth attendance (SBA) is an important proxy for quality of maternal care, and is negatively correlated with maternal death. The present cross-national ecological study aimed to examine the association between SBA and maternal death considering socioeconomic predictors of MMR across a broad range of countries, and World Bank World Development Indicators were extracted for 180 countries between 2010 and 2023. Hierarchical linear regressions were performed to examine the association between SBA and MMR adjusting for GDP per capita, life expectancy, female literacy, sanitation, adolescent fertility and health expenditures.

SBA ranges from 58.5% (low-income) to 98.8% (high-income) while the MMRs are 538.3 (low-income) to 19.3 (high-income). The correlations of SBA with MMR show a high degree of negative association (r = -0.775, p < 0.001). Once fully adjusted for wealth, social and demographic factors, the association between SBA and log(MMR) turned out to be non-significant (β = -0.004, p = 0.539). GDP per capita, life expectancy (β = -0.049, p = 0.010) and adolescent fertility (β = +0.006, p = 0.032) have remained significant independent predictors of log(MMR). The full adjusted model explained 81.4% of the variance in log(MMR).

While SBA was not an independent predictor of maternal death at the ecological level controlling for level of development in the country, its beneficial effects were included within country level social determinants. This must be interpreted with caution due to ecological fallacy and a cross-section study design. At the individual level, there are direct clinical benefits for mothers receiving skilled birth attendance. Sustained reduction in maternal mortality requires the combination of development inputs related to education, sanitation, reproductive health and access to health care.

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Published

2026-06-17

Issue

Vol. 5 No. 1 (2026)

Section

Original Research

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